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Surgical Teams Enhance Checklists, Build Teamwork
SEATTLE - (Nov. 15, 2010) - Anesthesiologists from Virginia Mason Medical Center recently presented the work of a multidisciplinary team to enhance the use of checklists during surgical procedures in an effort to improve patient safety. The presentation was given at the American Society of Anesthesiologists annual conference in October.
The use of a safety checklist before starting surgery was introduced in 2009 by a World Health Organization (WHO) taskforce under the direction of Dr. Atul Gawande of Harvard University. Early studies showed the use of preoperative checklists led to a reduction in error rates and adverse surgical events. One of the most effective tools to assure participation of all surgical team members is a preoperative briefing session, or huddle. Within the huddle, the checklist functions as an important framework, but must enlist introductions and input from the collective team to advance the level of communication and teamwork in every procedure.
Virginia Mason was an early adopter of checklists, but operating room staff observed that simply reading the checklist did not always produce participation from all team members. A task force of operating room nurses, surgical technicians, surgeons, residents and anesthesiologists revised the format of the checklist to enhance participation, communication and teamwork behaviors.
The new huddle format required each team member to announce his or her first and last name and attest that the portion of the checklist he or she had control or knowledge of was satisfactorily completed. For example, the surgical technician confirms the presence of required surgical instruments, while the surgeon outlines the planned procedure including details, such as estimated blood loss.
The new format earned accolades from a recent Joint Commission inspection at Virginia Mason, where the lead inspector observed, "This is the best preprocedural pause I have seen."
In early audits of the new process, every member of the surgical team verbally contributed and completed the requirements of their portion of the checklist more than 80 percent of the time. Additionally, the format enabled team members to introduce new information during the preoperative huddle at least 30 percent of the time.
"It may still be too early to tell if our enhanced checklist and huddle will mirror similar studies in the reduction of procedural errors, yet the increased communication and teamwork-related behaviors we're seeing in the operating room is encouraging," said Michael Mulroy, MD, Virginia Mason anesthesiologist. "We've converted a monologue-style checklist to a dynamic team huddle that will ultimately result in consistent team participation, increased morale and, most importantly, a safer surgical experience for our patients."
Virginia Mason's experience suggests other hospitals implementing the WHO Surgical Safety Checklist should take steps to ensure its performance includes elements of teambuilding and communication enhancement. In March, the Washington State Hospital Association was the first in the nation to claim adoption of preoperative checklists by 100 percent of its hospitals.
About Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a nonprofit comprehensive regional health care system in Seattle that combines a primary and specialty care group practice of more than 440 physicians with a 336-bed acute-care hospital. Virginia Mason operates a network of clinics throughout the Puget Sound area, and Bailey-Boushay House, a skilled-nursing facility and chronic care management program for people with HIV/AIDS. The medical center is affiliated with Benaroya Research Institute at Virginia Mason, internationally recognized in autoimmune disease research. Virginia Mason is known for applying manufacturing principles to health care to improve quality and patient safety. For more information, visit VirginiaMason.org or Facebook/VMcares or follow @VirginiaMason on Twitter.
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